Senator Wiener’s Recovery Incentives Act, Confronting the Growing Meth and Overdose Crisis, Passes Legislature and Heads to Governor’s Desk

SACRAMENTO – Senator Scott Wiener’s (D-San Francisco) legislation, Senate Bill 110, passed both the Assembly and the Senate on concurrence with bipartisan, unanimous votes. It will now head to the Senate for a concurrence vote, and then to the Governor’s desk, where it can be signed into law.

SB 110 will address the worsening methamphetamine addiction crisis facing our state. The Recovery Incentives Act legalizes the substance use disorder treatment known as “contingency management,” and authorizes Medi-Cal to cover it. Contingency management has proven to be the most effective method of treatment for methamphetamine addiction, and is frequently used as a treatment program by the Veterans Affairs Administration. This intervention program gives those struggling with substance use disorder financial rewards if they enter substance use treatment programs, stay in the program, and get and remain sober. This positive reinforcement helps people reduce and even fully stop substance use.

In the Biden-Harris administration’s new drug policy platform, increasing access to evidence-based treatment was slated as the number one priority. This includes contingency management. The platform cites the need to end “policy barriers related to contingency management interventions (motivational incentives) for stimulant use disorder” as part of its effort to expand evidence-based treatment.

There is currently no form of Medication-Assisted Treatment (MAT) for meth, unlike with opioids where treatment options such as methadone are available. Contingency management is thus a critical tool in addressing the meth addiction crisis. According to the San Francisco Department of Public Health (SFDPH), since 2008, meth overdose deaths in San Francisco have increased by 500%. Additionally, 50% of psychiatric emergency room admissions at San Francisco General Hospital are now meth-related. These disturbing statistics demonstrate the urgency with which San Francisco and other communities must address this epidemic.

With drug overdose deaths on the rise across the country, the state, and in San Francisco — San Francisco had a record number of overdose deaths in 2020 — effective substance use intervention programs are more important than ever. In San Francisco, according to data collected in 2019, roughly 60% of all overdose deaths were meth-related.

Meth use has spiked all over California and in San Francisco, and worsened through the COVID-19 pandemic. With social isolation, mental health issues like depression, and economic suffering all worse for many than in prior years, meth use has also increased significantly. Since COVID-19 was declared a national emergency on March 12th, The Hill reports that patients across the country “tested positive for methamphetamines at a roughly 20 percent higher rate between March and May than previous samples.”

Stimulant use has also grown rapidly in the LGBTQ and Black communities, which were already deeply impacted by the meth crisis. The LGBTQ community — particularly gay, bi and trans men — have seen a rapid increase in meth use as a party drug taken to enhance sexual experiences. SFDPH also reports that the mortality rate is highest among African American men.

Programs like the San Francisco AIDS Foundation’s PROP (Positive Reinforcement Opportunity Project) program – in which LGBTQ men who used meth are given gift cards for staying sober – are found to be highly effective. According to the San Francisco AIDS Foundation, in one year of the PROP program, 63% of participants stopped using meth entirely and another 19% reduced their use. This approach, coupled with community support meetings, proves time and again to be an effective method of treating meth addiction. Veterans Affairs hospitals throughout the state also use contingency management programs with success. This bill intends to make these programs accessible on a wider scale by authorizing them to be reimbursable by Medi-Cal.

The bill would also require the California Department of Health Care Services (DHCS) to issue guidance on the use of contingency management programs for Medi-Cal patients.

The bill is sponsored by the San Francisco AIDS Foundation, APLA Health, Equality California, the City and County of San Francisco, and the California Association of Alcohol and Drug Program Executives (CAADPE).

“We’re seeing meth overdose deaths skyrocket, and it’s clear that we need creative solutions for our addiction crisis,” said Senator Wiener. “We know that contingency management works; it’s one of the only effective and evidence-based treatments for stimulant addiction. Meth addiction is difficult to kick, and contingency management can help. We have every responsibility to help people succeed in abstaining from drugs that can be harmful to them and everyone in their community. Allowing state Medicaid funds to reimburse contingency management programs is an important step, and it’s something upon which legislators on both sides of the aisle can agree.”

“CSAM, California’s physician specialists in evidence based treatment, is proud to support this important bill which expands the use of contingency management for stimulant use disorder in California,” said CSAM President Dr. Anthony Albanese. “Currently there is no medication proven to treat stimulant use disorder,  Contingency management is therefore a critical component of treatment “

“Discrimination, stigma and shame are all barriers that prevent too many LGBTQ+ people from receiving the treatment they need to overcome meth use and addition. Enough is enough.” said Equality California Executive Director Rick Chavez Zbur. “I’m grateful that the California Assembly took bold action today to increase access to a proven, evidence-based solution to this crisis. Thanks to Senator Scott Wiener’s visionary leadership, The Recovery Incentives Act will improve and save the lives of countless LGBTQ+ Californians.”

"Contingency management programs are proven to help individuals maintain their health and are an effective relapse prevention strategy, by giving those struggling with substance use disorders positive reinforcement to remain in treatment,” said Al Senella, President, California Association of Alcohol and Drug Program Executives (CAADPE). “In this time of the need for public health safeguards, California should be using all known and effective strategies to address the growing need for substance use disorder services. Senator Wiener's continued leadership is pivotal in  bringing this effective treatment to California."

“With drug overdose deaths on the rise, effective substance use programs are now more important than ever – especially for the LGBTQ+ community,” said APLA Health Chief Executive Officer Craig E. Thompson. “In Los Angeles County alone, meth-related deaths increased over 900% from 2008 to 2018 and meth is now linked to more deaths than any other drug. SB 110 is a timely and urgent measure that will expand access to highly effective contingency management services and save lives. We applaud Senator Wiener for championing this critical issue and urge Governor Newsom to sign the bill into law as soon as possible.”

“Behind the rise in opioid overdose deaths in California lurks a rise in deaths by stimulant overdose,” statedVitka Eisen, President and CEO of HealthRIGHT 360. “We must use every available evidence-based intervention in order to address this challenge. Contingency management has a strong body of research supporting its effectiveness in treating methamphetamine addiction. The passage of SB 110 will give us an additional tool that can immediately save lives.”

“With an overdose crisis that gets worse every year, it’s time to invest in programs and services that we know will prevent overdose and improve the health and lives of people who use drugs,” said Kevin Rogers, interim CEO of San Francisco AIDS Foundation. “The success of our PROP program, which takes a harm reduction approach to help people who use stimulants like methamphetamine and cocaine reduce and stop their use, and many other contingency management programs demonstrates the positive impact these programs can have if they are scaled up and replicated. SFAF strongly supports SB 110, and we call on the Governor to sign this important bill into law. Thank you Senator Wiener for your leadership on this effort.”